Web-Enhanced Guideline Implementation for Post MI CBOC Patients
- Conditions
- Myocardial InfarctionComorbidity
- Interventions
- Behavioral: VA MI Plus Interactive
- Registration Number
- NCT00126750
- Lead Sponsor
- US Department of Veterans Affairs
- Brief Summary
To assist busy primary care clinicians in VA Community Based Outpatient Clinics (CBOCs) in managing complex patients by providing a single, interactive, and personalized source of information regarding applicable guidelines for post-MI patients. Specifically, 1) the investigators will identify barriers to provider adherence to guidelines within VHA clinics; 2) Apply guideline-based performance measures to electronic medical records (CPRS) and associated administrative data; 3) Implement the interactive Internet intervention developed by the NHLBI study, after inclusion of VA-specific components, including performance feedback for CBOC clinicians; and 4) Test hypotheses on the intervention's effectiveness, sustainability, and cost-effectiveness in both the VA and Medicare populations. This will include a randomized controlled trial with the CBOC as a unit of randomization.
- Detailed Description
Some 7.1 million Americans and an estimated 250,000 Veterans actively using VHA are Myocardial Infarction (MI) survivors. To date, most guideline interventions focus on a single patient condition, but ambulatory post-MI patients are frequently more complex, multiple comorbidities, and conflicting guidelines applicable to them. For example, whereas JNC-6 guidelines for the treatment of hypertension suggest pharmacological treatment at blood pressures above 140/80 mm Hg, to be initiated with diuretics or beta-blockers as first line agents, other guidance suggests that for post-MI patients with diabetes, treatment cut-offs should be lower and ACE-inhibitors may be considered as optimal first-line agents. On October 1, 2002, the University of Alabama at Birmingham (UAB) began a study funded by the National Heart, Lung, and Blood institute (NHLBI) as an RO1 (Kiefe, PI (25%), Weissman, co-PI (20%)) to conduct a randomized trial, MI-plus to increase provider adherence to guidelines for post-MI patients. That NHLBI-funded study targets Medicare beneficiaries and their primary care providers in Alabama. Its primary goal is to develop and test with a randomized controlled trial, an Internet-based multimodal guideline implementation strategy. The investigators propose, herewith, to extend and adapt this study to a nationwide sample of VA post-MI patients and their primary care providers in the VA.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 847
Potential subjects are defined as any VA-employed physician, PA, or CRNP who is a CBOC provider. All such providers will be offered the opportunity to participate and will have the option to agree to participate or not. Performance measure data from records of post-MI patients of the above providers will be extracted to test the experimental intervention. (Note: No individually identifying patient information will be extracted.) All VA-employed CBOC providers (physicians, PAs, CRNPs) will be offered the opportunity to participate in this study. Any subject may refuse to participate or to discontinue participation at will at any point in the study without consequence.
Potential subjects must be VA-employed physician, PA, or CRNP who is a CBOC provider. No such healthcare providers will be excluded from the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm 1 VA MI Plus Interactive -
- Primary Outcome Measures
Name Time Method Primary Outcome Was the Performance of Each Provider on Each of Seven Clinical Indicators 1/1/02 - 12/31/08 The investigators used an intent-to-treat approach for our main analysis, basing our outcome measures on provider's eligible patient population in each of the clinics. Performance improvement was calculated at the change (before vs after the intervention) the percentage of provider's patients with each clinical indicator. 1) change in the percentage of patients with improvements in LDL. Improvement defined as LDL-C level \< previous 18 mos; 2) Change in the percentage of patients with improvements in A1c. Improvement defined as HbA1c level \< previous 18 mos; 3) Change in percentage of patients prescribed Beta Blockers; 4) Change in the percentage of patients prescribed Statins; 5) Change in the percentage of patients prescribed ACEI or ARB; 6) Change in percentage of patients reaching target goal for LDL-C (\<100mg/dL); 7) Change in percentage of patients reaching target goal for HbA1c (\<8%).
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (40)
Overton Brooks VA Medical Center, Shreveport, LA
🇺🇸Shreveport, Louisiana, United States
VA Boston Health Care System, Jamaica Plain
🇺🇸Boston, Massachusetts, United States
Long Beach
🇺🇸Long Beach, California, United States
Bay Pines VA Healthcare System, Pay Pines, FL
🇺🇸Bay Pines, Florida, United States
VA Medical Center, Decatur
🇺🇸Decatur, Georgia, United States
Jesse Brown VAMC (WestSide Division)
🇺🇸Chicago, Illinois, United States
VA Illiana Health Care System
🇺🇸Danville, Illinois, United States
VA Medical Center Iowa City
🇺🇸Iowa City, Iowa, United States
VA Medical Center, Louisville
🇺🇸Louisville, Kentucky, United States
Edith Nourse Rogers Memorial Veterans Hospital
🇺🇸Bedford, Massachusetts, United States
VA Ann Arbor Healthcare System
🇺🇸Ann Arbor, Michigan, United States
Battle Creek, MI
🇺🇸Battle Creek, Michigan, United States
No Longer Valid, Use 528A8
🇺🇸Albany, New York, United States
Harry S. Truman Memorial VA Medical Center
🇺🇸Columbia, Missouri, United States
Kansas City VA Medical Center
🇺🇸Kansas City, Missouri, United States
VA Medical Center, St Louis
🇺🇸St Louis, Missouri, United States
Albany VA Medical Center: Samuel S. Stratton
🇺🇸Albany, New York, United States
Franklin Delano Roosevelt Campus of VAHVHCS
🇺🇸Montrose, New York, United States
New York, NY
🇺🇸New York, New York, United States
VA Medical Center, Cleveland
🇺🇸Cleveland, Ohio, United States
Coatesville, PA
🇺🇸Coatesville, Pennsylvania, United States
Lebanon, PA
🇺🇸Lebanon, Pennsylvania, United States
VA Medical Center, Providence
🇺🇸Providence, Rhode Island, United States
William S. Middleton Memorial Veterans Hospital
🇺🇸Madison, Wisconsin, United States
VA Eastern Kansas Health Care System - Topeka
🇺🇸Topeka, Kansas, United States
VA Medical Center, Birmingham
🇺🇸Birmingham, Alabama, United States
Carl T. Hayden VA Medical Center
🇺🇸Phoenix, Arizona, United States
VA Medical Center, Miami
🇺🇸Miami, Florida, United States
VA Medical Center, Cincinnati
🇺🇸Cincinnati, Ohio, United States
VA Salt Lake City Health Care System, Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Clement J. Zablocki VAMC
🇺🇸Milwaukee, Wisconsin, United States
San Juan VAMC
🇵🇷San Juan, Puerto Rico
VA Medical & Regional Office Center, White River
🇺🇸White River Junction, Vermont, United States
Fayetteville, AR
🇺🇸Fayetteville, Arkansas, United States
VA Connecticut Health Care System (West Haven)
🇺🇸West Haven, Connecticut, United States
VA Medical Center
🇺🇸Nashville, Tennessee, United States
VA Gulf Coast Veterans Health Care System
🇺🇸Biloxi, Mississippi, United States
VA New Jersey Health Care System, East Orange
🇺🇸East Orange, New Jersey, United States
Ralph H Johnson VA Medical Center, Charleston
🇺🇸Charleston, South Carolina, United States
Robert J. Dole VAMC & ROC
🇺🇸Wichita, Kansas, United States